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The development of resistance by infective bacterial species is an incentive to reconsider the indications and administration of available antibiotics. Correct recognition of the indications and duration of therapy are particularly important for the use of highly potent substances in the intensive care situation. There has as yet been no clinical chemical parameter which is capable of specifically distinguishing a bacterial infection from a viral or non-infectious inflammatory reaction, but it now appears that procalcitonin (PCT) offers this possibility. The present study was intended to clarify whether PCT can be used to guide antibiotic therapy in surgical intensive care patients. A total of 110 patients in a surgical intensive care ward receiving antibiotic therapy after confirmed infection or a high grade suspicion of infection were enrolled in this study. In 57 of these patients a new decision was reached each day as to whether the antibiotic therapy should be continued after daily PCT determination and clinical assessment. The control group consisted of 53 patients with a standardized duration of antibiotic therapy over 8 days. Demographic and clinical data were comparable in both groups. However, in the PCT group the duration of antibiotic therapy was significantly shorter compared to controls (5.9+/-1.7 vs. 7.9+/-0.5 days, p0.001) without unfavorable effects on clinical outcome.

Blood concentrations of thyrotropin-releasing hormone (TRH, Protirelin) were measured by a specific radioimmunoassay in 16 euthyroid subjects after intravenous (200 micrograms), nasal (2 mg) or oral (40 mg) administration of TRH. TRH blood levels peaked 2 min after i.v. administration (13,400 +/- 1,020 fmol/ml), 10 min after nasal (5,000 +/- 1,800 fmol/ml) and 150 min after oral (2,650 +/- 1,080 fmol/ml) administration. The degradation of TRH followed an exponential curve, giving a half-life of 6.5 min. The disappearance rate gave a "half-life" of 22 min in the nasal application group and of 31 min in the oral group. Maximal concentration of stimulated thyrotropin-stimulating hormone (TSH) always occurred 30 min after the peak TRH concentration without any correlation with the TRH concentration time integrals, suggesting that TSH secretion is dependent on a continually rising TRH blood level.

Manometric investigation of the gastro-esophageal closure mechanism is an important tool for the classification and adequate therapy of functional disorders in this region. Because of the relatively low pressure differences the reliability of a measuring procedure has to meet all requirements. Manometry by continuously perfused and withdrawn catheters being the most frequently applied measuring procedure got some criticism regarding its reliability and reproducibility. The theoretical basis of this criticism is examined closely. The reproducibility of the recorded pressure curves is studied and quantified in 36 dogs and 122 persons (32 controls, 63 patients with hiatal hernia, 27 patients with achalasia of the cardia). On experimental condition, lower esophagel sphincter pressure shows a high degree of reproducibility (retest reliability r = .98, p less than 0.001), in clinical investigations it is significantly lower (r = .81). There are no statistically significant differences between the patient groups and the controls. The importance of the findings for the reliability and the interpretation of clinical manometric data is discussed.